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5. ACUTE CARE > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

What are gram positive cocci?

A

Staphylcocci (including MRSA) - coagulase positive (e.g. Staph aureus) + coagulase negative (e.g. Staph epidermidis)

Streptococci: b-haemolytic (e.g. strep pyogenes, Group A strep) + a-haemolytic (e.g. strep pneumoniae - pneumococcus, strep mitior, strep mutans, strep sanguis)

Enterococci (non-haemolytic): E. faecalis - not a typical strep

Anaerobic streptococci

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2
Q

What are gram positive bacilli?

A

Aerobes: bacilus anthracis, corynebacterium diptheriae, listeria monocytogenes, nocardia species

Anaerobes: clostridium (C. difficile, C. botulinum, C. perfringens, C. tetani)

Actinomyces: A. israeli, A. naeslundii, A. odontolytic, A. viscosus

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3
Q

What are intracellular bacteria?

A 
Chlamydia (C. trachomatis, C psittaci, C. pneumoniae)
Coxiella burnetii
Bartonella and Erlichia
Rickettsia
Legionella pneumophilia
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4
Q

What are gram negative cocci?

A

Neisseria: N. meningitidis, N. gonorrhoea
Moraxella: (M. catarrhalis)

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5
Q

What are gram negative bacilli?

A 
Escherichia coli
Shigella
Salmonella
PSEUDOMONAS aeruginosa
HAEMOPHILUS INFLUENZAE
Camplyobacter jejuni
Citrobacteria freundii, C. koseri
Klebsiella pneumoniae, K. oxytoca
Enterobacter aerogenes E. cloacae
Serratia marascens
Proteus mirabilis
Morganelle morganiii
Providencia species: Yersinia (Y. pestis, Y. enterocolitica, Y. paratuberculosis)
Brucella species
Bordetella pertussis
Pasteurella multocida
Vibrio cholerae
Enterobacteriacaeae
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6
Q

What are anaerobes?

A

Bacteroides
Clostridium
Fusobacterium
Helicobacter pylori

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7
Q

What are mycobacteria?

A

M tuberculosis
M bovis
M leprae (leprosy)
Atypical (suspect if immunocompromised): many exist

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8
Q

What are spirochetes?

A

Borrelia burgdorferi (Lyme disease), B. recurrentis
Treponema (syphilis)
Leptospira

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9
Q

What are nucleic acid inhibitors?

A

Sulfonamides (+ and -)
Quinolones (- and +), B-lactamase resistant
Nitroimidazoles (+ and -)
Trimethoprim (+ and -)

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10
Q

What are cell wall inhibitors?

A

Penicillins (+&raquo_space; -)
Carbapenems (+ and -), B-lactamase resistant
Monobactam (-), b-lactamase resistant
Cephalosporins (+ or -), b-lactamase resistant
Vancomycin (+&raquo_space; -)
Teicoplanin (+&raquo_space; -)

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11
Q

What are protein inhibitors?

A 
Tetracyclines (+ and -)
Aminoglycosides (- >> +)
Macrolides (+ >> -)
Streptogramins
Chloramphenicol (+ and -)
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12
Q

What are sulfonamides?

A

Sulfadiazine, Sulfamethoxazole (+ and -)

Bacteriostatic, orally active, action prevented by pus (P-amino benzoic acid)

Widespread resistance to hospital acquired infections

Nausea and vomiting

Side effects: hypersensitivity reactions (common in drugs based in sulphur), bone marrow suppression

Replaced by antimicrobials with less resistance and less toxicity

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13
Q

What are quinolones?

A

Ciprofloxacin, norfloxacin nalidixic acid

  • and + (-ve better, but broad spectrum)

Beta-lactamase organisms resistant to penicillins and some cephalosporins

Good presumptive treatment but avoid in sepsis, does not cross BBB. Inhibits P450.

Uses: pyelonephritis, dysentry, severe gastroenteritis, pseudomonas

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14
Q

What are nitroimidazoles?

A

Metronidazole, tinidazole

Bactericidal, broad spectrum, important in serious anaerobic infections e.g. sepsis, orally active + against H. pylori

Interacts with ethanol, warfarin metabolism,

Bitter taste - (goes into breast milk)

Uses: PID, BV, trichomoniasis, anaerobic sepsis, infected wounds, C. difficile colitis, post surgery

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15
Q

What are penicillins?

A

Benzylpenicillin +»>- (pen G)
Phenoxymethylpenicillin (pen V; less active against -ve)
Flucloxacillin (methicillin not used anymore) +»>-
Amoxicillin +»-
Azlocicillin +>- and Piperacillin +>- (used for pseudomonas)

Bactericidal, fairly broad spectrum but better for gram positive

First line in rare diseases as orally available so work in range of areas, good bioavailability, orally active so work in range of areas, low adverse effects

Used for: pseudomonas, syphillis, meningitis (benzylpenicillin for pre-hospital management), UTI, bronchitis, pneumonia (anthrax, diphtheria, gas gangrene, leptospirosis, Lyme disease)

Hypersensitivity 1-10% of exposed individuals (0.05% anaphylaxis), more likely if atopic, should not be given β lactam antibiotics
Encephalopathy

Excreted in kidney: make sure no renal insufficiency, Na penicillin, K penicillin, often given IV

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16
Q

What are B-lactam antibiotics?

A

Has B lactam ring, however, not all B-lactam antibiotics are affected by the B-lactamase enzyme

Penicillins (flucloxacilin is B-lactamase resistant)

Cephalosporins

Vancomycin
Teicoplanin

Clauvulanic acid also has ring and inhibits beta-lactamase, given with amoxicillin (co-amoxiclav)

17
Q

What are cephalosporins?

A

Broad-spectrum, bactericidal (cefalexin, cefuroxime, cefotaxime, ceftriaxone, cefaclor, cefradine, cefalexin etc)

Cefalexin (po) +&raquo_space;>- -

Cefuroxime (po) -&raquo_space; + (B-lactamase resistant, cross BBB)

Cefotaxime iv -&raquo_space; + (B-lactamase resistant + cross BBB)- may lead to opportunistic inf e.g. Candida, C diff.

Used in surgical prophylaxis, ‘blind’ meningitis therapy (CEFTRIAXONE), UTI, peritonitis, pneumonia, septicaemia, biliary tract. CEFTRIAXONE for gonorrhoea.

Renal excretion, reduced dose in impairment

Note: 0.5-6.5% of pencillin sensitive pt will also react to cephalosporins. If cephalosporin essential in these pts as no suitable alternative, certain drugs from this class are better than others (e.g. cefotaxime and ceftriaxone can be used with caution)

18
Q

What is C. diff caused by? Tx?

A

High risk: cephalosporins, clindamycin, co-amox, ciprofloxacin. Medium risk: amoxicillin, macrolides, co-trimoxazole

Tx = metronidazole

19
Q

What are monobactams?

A

Aztreonam IV: gram -ve aerobic only

  • Beta lactamase resistant, side-effects similar to penicillins, no cross hypersensitivity, can be used in penicillin sensitive patients

Kidney excretion + short half life

Liver and marrow toxicity (should be bacteria specific as no cell walls, but are problems in liver and marrow as well)

Uses: H. influenzae, pseudomonas, gonorrhoea, meningitis

20
Q

What are tetracyclines?

A

Tetracycline, doxycline, + and -

Bacteriostatic, broad spectrum, widespread resistance therefore use limited

3,4,5,6 months of treatment, because lives in skin - reacts with sun, photosensitive response

Erythema and photosensitisation, tooth discolouration (causes more calcium to be stored in the teeth)

Uses: chlamydia, plague, brucellosis, zoonotic disease (undulant fevers, sweating wet hay like smell, migratory arthralagia and myalgia), CAP, cholera

21
Q

What are aminoglycosides?

A

Gentamicin, Streptomycin, Neomycin
- > +

Spectrum + resistance varies with individual drug, poor penetration of BBB, not orally active

Resistance a problem: bacteria makes drug degrading enzymes

Serious side effects:

* ototoxicity, (deafness)
* nephrotoxicity (netilmicin less toxic) * Renal assessment and drug monitoring required

Uses: MRSA, Gram -ve septicaemia, endocarditis -Streptococci or Staph

22
Q

What are macrolides?

A

Erythromycin +&raquo_space;> - (po)
Clarithromycin + > - (po, iv)
Azithromycin + > - (po, iv)

Similar range of action + efficacy to penicillins, alternative for penicillin sensitive individuals (aztreonam or clarithromycin can be used for penicillin allergy)

Can cause diarrhoea + jaundice, may have CYP450 interactions, blocks metabolism of warfarin and some antihistamines, also interacts with omeprazole (both inhibit same CYp450 enzyme)

Uses: Respiratory infection, otitis media, pertussis, legionnaire’s disease, bronchitis, H. pylori

23
Q

What is chloramphenicol?

A

Bacteriostatic, orally active
+ > -ve

Very toxic: bone marrow suppression, effects on newborns ‘grey baby syndrome’ - builds up in fetus, tends to only be used externally e.g. eye drops

Acts in same way as erythromycin but wider spectrum

Uses: conjunctivitis, meningitis, haemophilus influenza

Reserved for serious infections because of all of side effects

24
Q

Ones to remember

A
  • Sulfamethoxazole
  • Ciprofloxacin
  • Metronidazole
  • Trimethoprim
  • Flucloxacilin
  • Amoxicilin
  • Aztreonam
  • Cephalosporins
  • Vancomycin
  • Tetracycline
  • Clarithromycin (H. pylori)
  • Chloramphenicol
    • so toxic - used outside body now
25
Q

Dr F - Abx for gram positive

A

Flucloxacillin, benzylpenicillin, erythromycin, doxycycline, fusidic acid, clindamycin, vancomycin

26
Q

Dr F - Abx for gram negative

A

Gentamicin, trimethoprim, co-amoxiclav, cefalosporins

27
Q

Dr F - Abx for broad spectrum

A

Cefuroxime, cefotaxime, tetracyclines

28
Q

Dr F - Abx for extended broad spectrum

A

Ciprofloxacin, ceftazidime, piptazobactam, meropenem

29
Q

Dr F - Abx for anaerobic

A

Metronidazole, clindamycin,

30
Q

Dr F - antiviral / fungals

A

Viral: Acyclovir, ganciclovir
Fungal: Fluconazole, caspofungin, amphotericin

5. ACUTE CARE (5 decks)

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